EMDR Glossary: Dissociation in EMDR Therapy
This glossary entry is part of the EMDR Treatment and Training Resource Hub and explains how dissociation may present in EMDR therapy and how it can influence assessment, preparation, and trauma processing.
Dissociation can describe a wide range of experiences involving some degree of disconnection from present awareness, memory, perception, identity, emotion, or bodily experience. Some forms are common, such as becoming deeply absorbed in an activity or realizing you completed part of a familiar routine without paying much attention to it. Other forms involve greater disruptions in awareness or functioning and may require closer assessment during EMDR treatment.
For EMDR clinicians, dissociation raises several clinical questions. We want to understand what the client experiences, when it occurs, how easily the client reconnects with the present, and whether the pattern changes as emotional activation increases. Those distinctions can help us determine whether we are observing common attentional disengagement or a dissociative pattern that needs further assessment or preparation.
Dissociation Occurs on a Spectrum
Most people have experiences that involve some degree of absorption or reduced attention to the present. Someone may become absorbed in a book and lose track of time, complete a familiar task on autopilot, or realize that their attention drifted during a conversation. These experiences do not necessarily indicate clinically significant dissociation.
Dissociation becomes more clinically concerning when there are greater disruptions in memory continuity, perception, identity, body awareness, or connection with the present. A client might experience periods of time they cannot account for, feel detached from their body, experience their surroundings as unreal, or notice substantial changes in their sense of self or internal experience. Frequency, severity, functional interference, and what happens during emotional activation can all help clarify the presentation.
This distinction is useful in EMDR because two clients who both say that they “dissociate” may be describing very different experiences. One may briefly become distant when overwhelmed but remain aware of where they are and return to the conversation easily. Another may lose orientation or awareness, experience gaps in memory, or have difficulty reconnecting with the present once trauma-related material becomes active.
What Can Dissociation Look Like?
Dissociation does not have one presentation. Some experiences involve reduced connection with the environment, while others involve memory, bodily awareness, perception, or internal states. Clinicians may hear clients describe experiences such as:
mentally checking out during conversations and realizing they missed part of what was said
becoming deeply absorbed or functioning on autopilot
feeling detached from themselves or as though they are observing themselves from outside their body
feeling emotionally or physically numb
experiencing surroundings as foggy, distant, dreamlike, or unreal
having difficulty recognizing themselves or feeling connected with their usual sense of self
experiencing gaps in memory or periods of time they cannot account for
discovering actions or conversations they do not remember
experiencing shifts in internal perspectives or self-states
having difficulty determining whether an experience occurred in waking life, imagination, or dreaming
The context surrounding these experiences helps determine their clinical significance. Brief attentional drift during fatigue presents differently from repeated periods of unexplained time loss, and temporary detachment under stress presents differently from losing orientation when trauma material is discussed. Clinicians can look for patterns instead of interpreting a single experience in isolation.
For a closer look at memory continuity, Memory Gaps and Dissociation in EMDR Assessment discusses how clinicians can approach incomplete recall and memory discontinuity during EMDR history taking. Assessing Dissociation Before EMDR Trauma Processing addresses the broader question of when dissociative experiences warrant additional screening or assessment.
Dissociation, Depersonalization, and Derealization
Depersonalization and derealization are two forms of dissociative experience that frequently come up in clinical conversations. Depersonalization involves a sense of detachment from oneself or one's body. Clients may describe observing themselves from a distance, feeling unreal, or experiencing themselves as disconnected from their usual sense of self.
Derealization involves altered connection with the environment. A client might say that the room suddenly seems foggy, distant, unfamiliar, dreamlike, or unreal even though they know intellectually where they are. These experiences can become especially relevant during EMDR when they increase as emotional activation or trauma-related material is introduced.
Clinicians can observe whether the client remains oriented while these experiences occur and how readily connection with the present can be re-established. A dissociative experience that is recognized and resolves readily with reorientation provides different clinical information from one in which the client loses substantial awareness of the present. That distinction can become useful when evaluating preparation and readiness for trauma processing.
Dissociation and Trauma
Dissociation can occur as a protective response to overwhelming stress or trauma. Reducing awareness of an experience may allow a person to distance from emotional, sensory, or bodily information that is difficult to tolerate at the time. For some clients, similar patterns of disconnection continue to appear when later situations activate trauma-related material.
This does not mean that every dissociative experience indicates a trauma history or that the presence of trauma explains every episode of memory loss, detachment, or altered awareness. Clinicians still need to understand the client's individual presentation and consider other possible explanations when appropriate. The relationship between trauma and dissociation is assessed within the broader clinical picture.
During EMDR, we may learn more about that relationship by observing what happens as activation changes. A client may remain well oriented during ordinary conversation but begin to disconnect when discussing a particular period of their history. Another may report dissociative experiences in daily life but remain able to maintain connection with both trauma-related material and the present during therapy.
Why Dissociation Is Relevant in EMDR Therapy
EMDR trauma processing requires some ability to attend to distressing material while remaining connected with the present. This simultaneous connection is commonly discussed in terms of dual attention. Dissociation can interfere with that process when activation results in substantial loss of present orientation, awareness, or access to the material being processed.
The clinician therefore pays attention to how dissociation functions, especially as trauma-related material becomes active. Can the client recognize that they are beginning to disconnect? Can they communicate what is happening, remain oriented to the therapy environment, and reconnect with the present when support is provided?
These observations can help clinicians decide whether the client needs additional assessment or preparation before reprocessing. Dual Attention in EMDR: How to Assess It Before and During Trauma Processing examines this capacity more specifically, while How Dissociation Affects EMDR Preparation and Stabilization looks more broadly at how dissociative patterns can influence preparation.
Recognizing Patterns of Dissociation During EMDR
Dissociative patterns may become apparent during the initial history, but they can also emerge later. A client may report few dissociative symptoms during assessment and then begin to show changes in orientation, memory, bodily awareness, or internal experience when emotionally activating material is introduced. Observations across sessions can therefore add information that was not available during the initial evaluation.
The Dissociation Pattern Tracker & Clinical Guide helps clinicians organize these observations across several areas of dissociative experience. It distinguishes common attentional disengagement from patterns involving memory continuity, perception, identity or self-state shifts, internal experiences, and body awareness. Clinicians can also use it to record triggers associated with dissociation and the responses that help the client reconnect with the present.
→ Dissociation Pattern Tracker & Clinical Guide
Dissociation and EMDR Preparation
The presence of dissociation does not automatically mean that trauma processing cannot occur. Clinicians can consider how the client functions when activation increases and whether capacities such as present orientation, dual attention, grounding, affect tolerance, and internal communication remain available. Some dissociative presentations may call for additional preparation before a particular target is approached.
When dissociation becomes more pronounced during trauma discussion, the clinician may need to slow the pace and strengthen the client's ability to remain connected with the present. Repeated memory gaps, loss of orientation, substantial self-state shifts, or dissociation that continues despite grounding may also indicate a need for further assessment or preparation. The pattern being observed can help clinicians determine which additional assessment or preparation is appropriate.
The Dissociation-Informed EMDR Preparation: Clinical Decision Toolkit includes the Dissociation Pattern Tracker & Clinical Guide along with additional tools for deciding how dissociative patterns affect preparation. It can help clinicians connect what they are observing with decisions about stabilization, pacing, present orientation, and readiness for trauma processing.
→ Dissociation-Informed EMDR Preparation: Clinical Decision Toolkit
Learning More About Dissociation and EMDR Preparation
Dissociation can affect several areas clinicians consider during EMDR preparation, including grounding, dual attention, access to resources, internal cooperation, pacing, and readiness for trauma processing. These areas become especially relevant when dissociation increases as trauma-related material is approached. Clinicians may need to continue assessing these capacities as treatment progresses rather than relying only on what was observed during the initial evaluation.
EMDR Phase 2: Preparation, Stabilization, and Readiness for Trauma Processing provides more extensive education on dissociation, stabilization, grounding, dual attention, and readiness decisions during preparation. The course provides 4 CE credits through Cannon Psychology, an APA-approved sponsor of continuing education for psychologists, and 4 EMDRIA credits.
→ EMDR Phase 2: Preparation, Stabilization, and Readiness for Trauma Processing
The EMDR Preparation & Stabilization Hub brings together additional clinician education and resources related to preparation, dissociation, stabilization, dual attention, and readiness. It provides a broader starting point when the clinical question moves beyond defining dissociation and into planning preparation for a particular client.
→ EMDR Preparation & Stabilization Hub
Conclusion
Dissociation describes a broad range of experiences, and recognizing that range helps clinicians avoid treating every episode of disconnection as clinically equivalent. Brief absorption or attentional disengagement may require little clinical response, while disruptions in memory continuity, perception, identity, body awareness, or present orientation may warrant closer assessment. The client's pattern across situations and levels of activation provides information that a single symptom cannot.
In EMDR therapy, the next question is often how that pattern affects the client's ability to remain connected with the present while trauma-related material is active. Observing present orientation, dual attention, communication, and the client's ability to reconnect can help clinicians determine whether further assessment or preparation is needed. Dissociation then becomes part of the treatment-planning picture rather than a stand-alone finding.
Research References
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004
Leeds, A. M., Madere, J., & Coy, D. (2022). Beyond the DES-II: Screening for dissociative disorders in EMDR therapy. Journal of EMDR Practice and Research, 16(3), 123–138. https://doi.org/10.1891/EMDR-2022-0014
Paulsen, S. L. (1995). Eye movement desensitization and reprocessing: Its cautious use in the dissociative disorders. Dissociation, 8(1), 32–44. https://hdl.handle.net/1794/1592
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
